Breast Screening East Coast Style

Breast Screening
East Coast Style
Te Puia 2008 - 2010
BREASTSCREEN AOTEAROA
BreastScreen Aotearoa (BSA) is free for
women:
aged 45-69
with no symptoms of breast cancer
who have not had a mammogram in the
last 12 months
who are not pregnant or breastfeeding
THE BREASTSCREEN PATHWAY
For every 200 women
having a first screen
18 will be recalled to
assessment
2 will have breast
cancer
For every 200 women
returning for a
screen
8 will be recalled to
assessment
1 will have breast
cancer
BENEFITS OF SCREENING
TARGET = 70% OF ALL ELIGBLE WOMEN
WOMEN OVER 50
YEARS
NO
BIANNUAL
SCREENING
SCREEN
% RISK
REDUCTION
CHANCE OF
GETTING BREAST
CANCER
1 IN 17
1 IN 17
0
CHANCE OF DYING
FROM BREAST
CANCER
1 IN 70
1 IN 100
30%
BSCC
REGIONAL
PROFILE
Taranaki DHB
Wanganui DHB
MidCentral DHB
Hawkes Bay DHB
Tairawhiti DHB
POPULATION
Territorial Authority
45-49 Years 50-54 Years 55-59 Years 60-64 Years 65-69 Years Totals by TLA
Horowhenua District
1,026
960
1,041
972
921
4,920
Manawatu District
1,095
987
858
687
564
4,191
Palmerston North City
2,580
2,202
2,007
1,521
1,254
9,564
Tararua District
642
615
513
417
372
2,559
Central Hawke's Bay District
480
513
456
324
297
2,070
Chatham Islands Territory
24
18
18
12
9
81
Hastings District
2,712
2,355
2,172
1,689
1,350
10,278
Napier City
2,019
1,845
1,929
1,416
1,281
8,490
Wairoa District
354
282
282
183
159
1,260
Gisborne District
1,680
1,428
1,230
936
828
6,102
New Plymouth District
2,739
2,328
2,193
1,638
1,503
10,401
South Taranaki District
936
819
744
636
531
3,666
Stratford District
318
246
264
210
204
1,242
Rangitikei District
555
495
468
381
348
2,247
Ruapehu District
531
438
396
297
201
1,863
Wanganui District
1,641
1,470
1,332
1,098
1,104
6,645
Totals by Age
19,332
17,001
15,903
12,417
10,926
75,579
POPULATION
Territorial Authority
45-49 Years 50-54 Years 55-59 Years 60-64 Years 65-69 Years Totals by TLA
Horowhenua District
171
153
105
93
72
594
Manawatu District
90
81
54
45
30
300
Palmerston North City
255
171
144
102
51
723
Tararua District
93
93
54
36
33
309
Chatham Islands Territory
12
9
12
3
3
39
Central Hawke's Bay District
75
69
51
27
30
252
Hastings District
483
378
303
237
141
1,542
Napier City
267
213
174
117
96
867
Wairoa District
186
123
111
75
66
561
Gisborne District
675
513
390
270
249
2,097
New Plymouth District
279
189
153
102
84
807
South Taranaki District
165
108
90
87
72
522
Stratford District
24
12
24
9
12
81
Rangitikei District
108
75
81
51
45
360
Ruapehu District
153
138
108
69
51
519
Wanganui District
276
225
159
120
99
879
Totals by Age
3,312
2,550
2,013
1,443
1,134
10,452
POPULATION EAST COAST
Maori women aged 45 to 69
East Coast = 2,470
Tolaga Bay and Potaka = 444
PRIMARY HEALTH CARE
Ngati Porou Hauora PHO runs all
Primary Health Care clinics on the East
Coast. These are at:
Tolaga Bay
Tokomaru Bay
Ruatoria
Te Puia [Tawhiti]
Tikitiki
Te Araroa - [Matakaoa]
EAST COAST STYLE
“When the wave comes go with it coz
you don’t know when the next one is
coming”
“Get it right for Maori and you get it
right for all”
Dr Pat Ngata
HOW WE WORK TOGETHER
Te Aitanga A Hauiti Trust (Hauiti Hauora) are Tairawhiti’s Independent
Service Provider (ISP) for BSA. (Iwi Service Provider)
ISP’s are contracted by the NSU since 1999 to provide:
Health Promotion
Support /access to all of BSA pathway.
On the East Coast this includes transport to Hastings for any
assessments required after mammograms
Long term approach of working WITH (Joint Venture) Hauiti,
Ngati Porou & BSCC to encourage women to take part
2008 - Piloted a new way of working within the joint venture
THE MOBILE SERVICE IN TE PUIA
2000 First mobile visit followed by another in 2002
2004 First annual visit to Te Puia Springs
2004 PHA conference report about different way of Mobile
working to fit in with Coast lifestyle
Only mobile site visited annually to ensure
Geographical needs are met
Flexibility to encourage attendance
THE BSCC MOBILE
WHEN
THE
MOBILE
ARRIVES
LESSONS LEARNED
2008 - 2010
Whanau Ora Approach
Acknowledgement that ALL need to work
together (using vote health $$) in the
provision of a healthy women service.
Contracts, perceived power bases and old
problems have no place in women centred
services.
Whanau Ora Approach
Step One - nurse to nurse approach from BSCC
Discussion on Whanau Ora principles
PHC clinic buy-in critical for success
Making informed decisions takes time
Step Two – practical administration support from BSCC
Targeted and useful information from BSCC to PHC
Provision of lists of screened women by clinic
Literally cut and pasted!
Follow up
Follow up
Follow up
and
FOLLOW UP !!!!
CRITICAL FACTORS
Strong relationships/support for local clinics
from BSCC
BSCC staff trained to meet needs of women
(East Coast style)!
Appointments made by clinic location to assist with
transport.
Flexible staffing, flexible appointment times, flexible
culture adopted by BSCC to cope with the Coast mahi and
timeframes.
BSCC 0800 staff advise women to contact their clinic for
transport and support.
NO USE IS
ABUSE
MOLLY PARDOE
MNZM
CRITICAL FACTORS
TRANSPORT
Some women still over 1 - 2 hours away (even though a mobile service)
Organised groups with transport essential for good attendance
Bookings by clinic (and thus geography) made this possible
FAMILIARITY
Local women make contact with eligible women prior to mobile visit
Local women contacting women not already enrolled (already known by
the people as part of the programme)
Local ISP coordinating the journey - transport / appointment times /
DNA’s / group bookings / lunch and a lot of laughter
Local BSCC Maori Health Promoter
Proven service – 10th visit in 10 years
NOT TOO MUCH FAMILIARITY
Not all locals want whanau/friends to know their business
F
F
U
T
S
!
!
!
!
S
N
E
P
P
A
H
GOOD STUFF
Record screening numbers
women had first mammogram returned to service
SAD STUFF
Tangihanga
AND OF COURSE FUNNY STUFF
POLLYANNE TAARE
ISP HAUITI HAUORA
AND THEN
THESE
GUYS TURNED
UP!!!
Evaluation:
Every third woman contacted - 34 provided feedback
It was OK to tino pai.
We need more service like this
that make you feel good and happy
That’s what we need, more
good service for our people
Thank you very much for bringing a
person who cannot drive to
breast screening.
Makes it so much easier to keep
appointment when transport is assured.
Big thanks for warming cup of
tea and muffin
Delighted at being given pick up service.
Screening of breast apparatus many
times better than ever before, will
welcome further testing
Statistics 2008 – 2010
Wahine Kahurangi Project
IMPORTANT A & F WORDS
A
whina
A
ccess
A
roha
F
ace to face
F
requent contact
F
ocus on women
ood and
un
A
F
F
ppropriate Support
A
ll Sharing
TAKE HOME MESSAGES
ONE message FOR all and BY all
Women centred processes
Respecting and working with local
custom
Continuity of BSCC and Hauiti
relationships with local women is
critical to sustainable service
Local clinics, Hauiti ISP & BSCC staff
all being seen as part of SAME service
ACKNOWLEDGEMENTS
Molly Pardoe
Violet Crawford
Pollyanne Taare
Ann Shaw